10.2 Height, Weight, and Specimen Collection (Skill 14)

10.2 Height, Weight, and Specimen Collection (Skill 14)

Quick Answer: Skill 14: non-skid footwear before walking to the scale; set the scale to zero before the client steps on; client stands in the center; step off; wash before recording. Critical element: ±2 lb or ±0.9 kg of the evaluator. The Colorado handbook requires you to zero both a standing scale and a non-digital bathroom scale. Weigh at the same time of day, in similar clothing, after voiding if possible. Report a sudden gain (often fluid). Height: shoes off, heels against the measure. Specimens: midstream clean-catch, stool, sputum — label at the bedside, do not contaminate the lid, gloves, biohazard bag. Never leave a specimen in the dining room or take a container to the dining table. Stool occult blood and 24-hour urine follow the nurse; keep the 24-hour jug on ice if required.

Why height, weight, and specimens sit in I.B.3

Weight is a measurement skill. Height and specimens show up on the written test as technical procedures: how you collect, label, and protect a sample, and how you produce a number the care team can trust. A wrong weight hides heart-failure fluid. A mislabeled urine cup can send another client's result to the lab.

The Colorado Skills Evaluation always includes one measurement skill. Skill 14 — Measures and Records Weight of Ambulatory Client is on that list with electronic blood pressure, urinary output, radial pulse, and respirations. You record the result on the digital Candidate Results form.

The handbook also states, in the Skill Evaluation tips, that you must know how to use both a standing and a non-digital bathroom scale and must know how to set both types of scales to zero. That sentence is test-day equipment knowledge, not optional trivia. You may not bring your own scale.

/practice/co-cnaPractice questions with detailed explanations

Skill 14 — Measures and Records Weight of Ambulatory Client

Handbook sequence:

1. Explains the procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Client has non-skid shoes/footwear on before walking to the scale.
3. Before the client steps on the scale, the candidate sets the scale to zero.
4. Asks the client to step on the center of the scale and obtains the weight.
5. Asks the client to step off the scale.
6. Before recording, washes hands.
7. Critical element: Records the weight based on the indicator on the scale. Weight is within plus or minus 2 lbs of the evaluator's reading. If recorded in kg, within plus or minus 0.9 kg.

Zero both kinds of scale

Colorado expects both:

• Standing balance (beam) scale: slide the large and small weights to zero so the beam balances at the center mark before anyone stands on the platform. After the person is centered, move the large weight, then the small weight, until the beam balances again. Read the sum of the two weights.
• Non-digital bathroom scale: look at the dial. Use the zero-adjust (usually a knob or screw) so the needle sits on 0 with nobody on the scale. Then have the person step on the center. Read the needle at eye level.

A scale that still shows 3 lb from the last person will add 3 lb to your reading and can blow the ±2 lb critical element by itself. Zero every time, not just at the start of the day. Narrating I would have zeroed it does not replace actually setting the indicator to zero.

Clinical weight rules that written items test

• Same time of day — morning weights are the usual comparison.
• Similar clothing — a bathrobe plus wet shoes is not the same as a gown.
• After voiding if possible — a full bladder is extra weight that is not fluid in the tissues, but it still changes the number.
• Non-skid footwear for the walk — Skill 14 is an ambulatory skill. You do not send a sock-footed client across tile. You also do not weigh with a heavy winter coat if the baseline was in a gown.
• Report a sudden gain. Two or three pounds overnight is often fluid, not a big dinner. Report a sudden loss the same way.

You do not diagnose heart failure. You say: usual weight 154 lb, today's weight 158 lb, same scale, after voiding, nurse notified.

Height

Height is not Skill 14, but I.B.3 written items still ask it.

• Remove shoes.
• Stand straight, eyes forward.
• Heels against the measuring bar or wall measure, feet flat, headpiece to the crown.
• Record the unit the form asks for (inches or centimeters) and do not invent a conversion you were not taught.

A sitting or bed height is used only when the person cannot stand and the nurse or care plan directs the method. You do not guess height from the admission face sheet if you were assigned to measure.

Specimen collection

A specimen is a sample of body material sent to the laboratory. The CNA often collects urine, stool, and sputum. The CNA does not draw blood — venipuncture is not basic Colorado CNA scope.

Shared rules for every specimen:

1. Confirm the order, the client identity, and the type of specimen.
2. Wash, glove, and explain.
3. Collect into the correct container — sterile cup for a clean-catch culture, clean hat or pan for a stool that will be transferred, sputum cup — not a water glass from the overbed table.
4. Do not contaminate the inside of the lid or the rim. Set the lid face up on a clean barrier if you must set it down; never rest the inner lid on the sink.
5. Label at the bedside immediately: name, identifier, date, time, type of specimen, and your initials per facility policy. Do not pre-label empty cups in the utility room and then guess who used which one.
6. Place the container in a biohazard bag.
7. Take it to the designated dirty utility or lab pickup now.
8. Never leave a specimen on a meal tray, in the dining room, on a clean overbed table next to water, or at the nursing-station snack area.

Midstream clean-catch urine

A midstream clean-catch reduces skin bacteria so the culture reflects bladder urine.

• Clean the perineal area as trained (front to back for a female; circular at the meatus for a male) with the provided wipes.
• The person starts the stream into the toilet or hat.
• Move the sterile cup into the stream after the first part of the void, then remove it before the stream ends.
• Do not touch the inside of the cup. Cap it without dragging the rim on the toilet.

The first part of the stream washes organisms from the urethra. That is why it is discarded.

Stool and occult blood

For a routine stool specimen, use a clean hat or bedpan. Transfer stool with the supplied stick into the container without overfilling.

For stool occult blood (hidden blood), follow the nurse's instructions and the card that comes with the cards or vials. Do not mix toilet-bowl water or urine into the smear. Report visible red blood or black tarry stool to the nurse immediately — that is an observation, not a reason to skip the ordered test.

Sputum

Sputum is mucus from the lungs, not saliva. Best collected in the morning before food if the order allows. The person sits up, rinses the mouth with water if directed (not mouthwash unless ordered), and coughs deeply into the cup. A spit of saliva is not a sputum specimen. Report if the person cannot produce sputum.

24-hour urine

Follow the nurse's instructions exactly. Typical teaching:

• At the start time, the person voids and you discard that first void — the bladder is now empty as the clock starts.
• Collect every void for the next 24 hours into the jug.
• At the end time, the person voids again and that last void goes into the jug.
• Keep the jug on ice or refrigerated if required by the lab and the nurse.
• If any void is flushed by mistake, tell the nurse. Do not secretly start over at a random hour or pour water into the jug to make up volume.

Never take a specimen to the dining table

This is both infection control and dignity. A urine cup next to oatmeal is a contamination event and a rights problem. If the person is in the dining room when the lab run is due, you collect in the bathroom or the room, label there, bag it, and send it. You do not park the container on the table just for a minute.

Colorado scenario

You are assigned Skill 14 in a Fort Collins skills lab. The volunteer is in socks. The beam scale still shows the last candidate's 3-pound leftover. You wave the person onto the edge of the platform, read 147, write 147 with unwashed hands, and tell the evaluator you would have zeroed it if this were a real client.

The card does not give credit for narrating the zero. Non-skid footwear before walking. Zero before the person steps on. Center of the scale. Step off. Wash, then record. Land within ±2 lb (or ±0.9 kg). Know both the standing beam scale and the non-digital bathroom scale.

The next week on a Denver unit, Mr. Hale's 0600 weight is 6 lb above yesterday. He has non-skid slippers. You zeroed the standing scale. He voided first. You report the sudden gain to the licensed nurse before breakfast trays, then document. Later the nurse asks for a midstream urine and a 24-hour jug already on ice. You label the clean-catch in his bathroom, bag it, and walk it to dirty utility. You do not set either container on his roommate's dining tray. When a nursing student flushes one 24-hour void, you tell the nurse — you do not add tap water.

Height on admission the same morning: shoes off, heels against the measure, headpiece to the crown. You do not copy last year's clinic height because the person is tired of standing.

Exam traps

• Walking the person to the scale in socks.
• Forgetting to zero, or zeroing after the person is already on the platform.
• Standing on the edge of the platform.
• Recording before washing.
• Treating ±2 lb and ±0.9 kg as a 10-pound whatever is close enough rule.
• Labeling specimens at the desk after three cups sit in a pocket.
• Leaving a urine cup in the dining room or on a meal tray.
• Keeping the first 24-hour void instead of discarding it.
• Guessing height with shoes on.